Benchmarking Outpatient Oncology: How do you stack up?

1. Benchmarking Outpatient Oncology: How do you stack up?

2. Count what counts… • Why?

3. Count what counts… • How? 2013 Report on 2012 Data Fall 2013 Report

4. Practice location(105 practices in 35 states)

5. Practice size

6. Business structure(93 practices, 814 FTE physicians)

7. 10-year-old data sharing collaborative • ~40 large practices across the country • Two face-to-face meetings/year to share data and best practices

8. Count what counts… • What? 1. Drugs 2. Staffing and productivity 3. Clinical measurement

9. #1. Drugs • Expense (COGPF) • Operations • Risk

10. Drug Procurement(89 practices, 634 FTE HemOnc)

11. Practice Expense MixHematology/oncology

12. COGPF

13. Revenue MixHematology/oncology Note: Retail/CD is Gross Revenue

14. Drug revenue

15. Net drug revenue

16. Net drug revenue as % of COGPF

17. Total medical revenue (less rad onc)

18. Net medical revenue

19. E/M revenue Infusion revenue

20. Inventory on hand at end of 12-month period. Business days inventory on hand is calculated by dividing ending inventory by COGPF per business day (254).

21. Physician dispensing A closed door/retail pharmacy is defined as a licensed entity that provides pharmacy services to patients and employees of the practice but is not available to the public at large (note that not all states allow this practice). A physician dispensing unit is defined as a non-licensed entity which allows physicians to stock and dispense medications (generally oral) to patients of the practice.

22. #2. Staffing and Productivity • Physician productivity • Staff productivity

23. New patients New patient volume in the practice continues to be an important measure of productivity and an essential tool for strategic planning. Survey respondents reported the number of hematology/oncology new patients that entered the practice in the 12-month period by place of service (office or inpatient hospital). A new patient is defined as one that has not received services in the practice in the last three years.

24. New patients, office New patients, hospital

25. Visit counts Office established patient visits include CPT codes 99212 – 99215. Hospital established patient visits include CPT codes 99217-99220, 99231-99233, 99234-99236, 99328-99239.

26. wRVU The resource-based relative value system (RBRVS) assigns a relative value to each procedure code based on physician work, practice expense and professional liability expense. Relative value units (RVUs) are used by many payers to determine reimbursement for services and are available on the CMS website. wRVU refers to the physician work component assigned to each code and is an important element of physician productivity measurement. This data represents total wRVU attributed to the physician.

27. wRVU

28. wRVU, office E/M & infusion services wRVU, E/M services only

29. wRVU, office E/M services only wRVU, hospital E/M services only

30. FTE Staff All includes staff working in all departments/specialties in the practice. Includes all staff; does not include physicians. FTE Staff HemOnc includes all staff working in the hematology/oncology line of business. Includes all staff; does not include physicians.

31. Staff pay/physician

32. Non-physician practitioners (NPP)(nurse practitioners and physician assistants) FTE NPP/physician Pay/FTE NPP

33. HemOnc NPP productivity: NPP wRVU/HemOnc HemOnc NPP productivity: NPP wRVU/NPP

34. FTE billing staff includes all staff involved in the billing and collecting process in the practice, all departments/specialties. FTE patient financial advocates include all staff involved in the patient financial counseling process for the practice, all departments/specialties.

35. Billing staff productivity

36. FTE chemo admin staff includes all staff responsible for drug purchasing, drug mixing and preparation, delivery to patients, documentation of services provided, and management of these processes. Staff is included in proportion to the amount of time spent on chemotherapy management activities.

37. Chemo admin staff productivity

38. Radiation Oncology Average daily treatments is calculated by dividing the total number of treatments in the period (12 months in this case) by the number of business days in the period (254).

39. New patients

40. Staff/FTE LinAc

41. #3. Clinical measurement • Speed • Outcomes • Value

42. Embrace technology • Staging frequency • Intent of therapy • Adverse event grade • Disease status • Patient status • Line of Therapy

43. Staging • Treatment Setting (Line of Therapy) • Treatment intent (Goal of Therapy) • Disease Status • Patient Performance Status • Toxicity

44. Measure what matters …. and then make measurements impactful • Show each physician their individual objective performance on these metrics. • Use names for close working groups where names will be recognized. • Use arrays for individual placement in large populations. • Push the information – don’t expect that they will come.

45. Practice/physician specific

46. Composite by practice average

47. Composite by HemOnc

48. All reporting physicians

49. Count what counts… • Why? • How? • What? • Drugs • Staffing, productivity • Clinical measurement • Measure what matters

50. Questions? Thomas R. Barr, MBA General Manager Oncology Metrics, a division of Altos Solutions, Inc. Direct: 603.496.7215 tbarr@oncomet.com